| NPI | 1669262713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CHRISTENSEN Credentialing Specialist 801-691-1701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| 1223P0300X Dentist Periodontics | |
| Enumeration Date | 2025-05-12 |
| Last Update Date | 2025-05-12 |